Continuing increased risk of second cancer in long-term testicular cancer survivors after treatment in the cisplatin era

Int J Cancer. 2020 Jul 1;147(1):21-32. doi: 10.1002/ijc.32704. Epub 2019 Nov 1.


Using complete information on total treatment burden, this population-based study aimed to investigate second cancer (SC) risk in testicular cancer survivors (TCS) treated in the cisplatin era. The Cancer Registry of Norway identified 5,625 1-year TCS diagnosed 1980-2009. Standardized incidence ratios (SIRs) were calculated to evaluate the total and site-specific incidence of SC compared to the general population. Cox regression analyses evaluated the effect of treatment on the risk of SC. After a median observation time of 16.6 years, 572 TCS developed 651 nongerm cell SCs. The SC risk was increased after surgery only (SIR 1.28), with site-specific increased risks of thyroid cancer (SIR 4.95) and melanoma (SIR 1.94). After chemotherapy (CT), we observed 2.0- to 3.7-fold increased risks for cancers of the small intestine, bladder, kidney and lung. There was a 1.6- to 2.1-fold increased risk of SC after ≥2 cycles of cisplatin-based CT. Radiotherapy (RT) was associated with 1.5- to 4.4-fold increased risks for cancers of the stomach, small intestine, liver, pancreas, lung, kidney and bladder. After combined CT and RT, increased risks emerged for hematological malignancies (SIR 3.23). TCS treated in the cisplatin era have an increased risk of developing SC, in particular after treatment with cisplatin-based CT and/or RT.

Keywords: cancer epidemiology; chemotherapy; germ cell; radiotherapy; second cancer; surgery; survivorship; testicular cancer.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Cisplatin / administration & dosage
  • Cohort Studies
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neoplasms, Germ Cell and Embryonal / drug therapy*
  • Neoplasms, Germ Cell and Embryonal / epidemiology*
  • Neoplasms, Germ Cell and Embryonal / radiotherapy
  • Neoplasms, Germ Cell and Embryonal / surgery
  • Neoplasms, Second Primary / epidemiology*
  • Norway / epidemiology
  • Registries
  • Risk
  • Testicular Neoplasms / drug therapy*
  • Testicular Neoplasms / epidemiology*
  • Testicular Neoplasms / radiotherapy
  • Testicular Neoplasms / surgery
  • Young Adult


  • Cisplatin

Supplementary concepts

  • Testicular Germ Cell Tumor